Petry Tarissa Z, Fabbrini Elisa, Otoch Jose P, Carmona Murilo A, Caravatto Pedro P, Salles João E, Sarian Thais, Correa Jose L, Schiavon Carlos A, Patterson Bruce W, Cohen Ricardo, Klein Samuel
Center for Obesity and Diabetes, Hospital Oswaldo Cruz, Sao Paulo, Brazil.
Discipline of Endocrinology, Santa Casa Medical School, Sao Paulo, Brazil.
Obesity (Silver Spring). 2015 Oct;23(10):1973-9. doi: 10.1002/oby.21190.
To determine whether upper gastrointestinal tract (UGI) bypass itself has beneficial effects on the factors involved in regulating glucose homeostasis in patients with type 2 diabetes (T2D).
A 12-month randomized controlled trial was conducted in 17 overweight/obese subjects with T2D, who received standard medical care (SC, n = 7, BMI = 31.7 ± 3.5 kg/m(2) ) or duodenal-jejunal bypass surgery with minimal gastric resection (DJBm) (n = 10; BMI = 29.7 ± 1.9 kg/m(2)). A 5-h modified oral glucose tolerance test was performed at baseline and at 1, 6, and 12 months after surgery or starting SC.
Body weight decreased progressively after DJBm (7.9 ± 4.1%, 9.6 ± 4.2%, and 10.2 ± 4.3% at 1, 6, and 12 months, respectively) but remained stable in the SC group (P < 0.001). DJBm, but not SC, improved: (1) oral glucose tolerance (decreased 2-h glucose concentration, P = 0.039), (2) insulin sensitivity (decreased homeostasis model assessment of insulin resistance, P = 0.013), (3) early insulin response to a glucose load (increased insulinogenic index, P = 0.022), and (4) overall glycemic control (reduction in HbA1c with fewer diabetes medications).
DJBm causes moderate weight loss and improves metabolic function in T2D. However, our study cannot separate the benefits of moderate weight loss from the potential therapeutic effect of UGI tract bypass itself on the observed metabolic improvements.
确定上消化道（UGI）旁路手术本身对2型糖尿病（T2D）患者调节葡萄糖稳态的相关因素是否具有有益作用。
对17名超重/肥胖的T2D患者进行了一项为期12个月的随机对照试验，这些患者接受标准医疗护理（SC，n = 7，体重指数[BMI]=31.7±3.5kg/m²）或十二指肠空肠旁路手术并进行最小化胃切除（DJBm）（n = 10；BMI = 29.7±1.9kg/m²）。在基线以及手术后或开始接受标准医疗护理后的1、6和12个月进行5小时改良口服葡萄糖耐量试验。
DJBm术后体重逐渐下降（1、6和12个月时分别下降7.9±4.1%、9.6±4.2%和10.2±4.3%），而SC组体重保持稳定（P<0.001）。DJBm改善了：（1）口服葡萄糖耐量（2小时血糖浓度降低，P = 0.039），（2）胰岛素敏感性（胰岛素抵抗稳态模型评估降低，P = 0.013），（3）对葡萄糖负荷的早期胰岛素反应（胰岛素生成指数增加，P = 0.022），以及（4）总体血糖控制（糖化血红蛋白降低且糖尿病药物使用减少），而SC组未改善。
DJBm可导致T2D患者适度体重减轻并改善代谢功能。然而，我们的研究无法将适度体重减轻的益处与UGI旁路手术本身对所观察到的代谢改善的潜在治疗效果区分开来。
